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An Exploratory Study of Primary Care Physician Decision Making Regarding Total Joint Arthroplasty

Journal of General Internal Medicine volume 22, pages 74–79 (2007)Cite this article

Background

For patients to experience the benefits of total joint arthroplasty (TJA), primary care physicians (PCPs) ought to know when to refer a patient for TJA and/or optimize nonsurgical treatment options for osteoarthritis (OA).

Objective

To evaluate the ability of physicians to make clinical treatment decisions.

Design and participants

A survey, using ten clinical vignettes, of PCPs in Indiana.

Measurements

A test score (range 0 to 10) was computed based on the number of correct answers consistent with published explicit appropriateness criteria for TJA. We also collected demographic characteristics and physicians’ perceived success rate of TJA in terms of pain relief and functional improvement.

Results

There were 149 PCPs (response rate = 61%) who participated. The mean test score was 6.5 ± 1.5. Only 17% correctly identified the published success rate of TJA (i.e., ≥90%). In multivariate analysis, the only physician-related variables associated with test score were ethnicity, board status, and perceived success rate of TJA. Physicians who were white (P = .001), board-certified (P = .04), and perceived a higher success rate of TJA (P = .004) had higher test scores.

Conclusions

PCP knowledge with respect to guideline-concordant care for OA could be improved, specifically in deciding when to consider TJA versus optimizing nonsurgical options. Moreover, the perception of the success rate of TJA may influence a clinician’s decision making.

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Acknowledgment

Dr. Ang is supported in part by a Mentored Patient Oriented Career Development Award (RR017725) from the National Center for Research Resources (NCRR), National Institutes of Health.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Indiana University School of Medicine, 1110 West Michigan St., Room 545, Indianapolis, IN, 46202, USA

    Dennis C. Ang MD, MS & Kathleen Thomas DO

  2. Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Incorporated, Indianapolis, IN, USA

    Kurt Kroenke MD

  3. Division of General Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Kurt Kroenke MD

  4. VA HSR&D Center on Implementing Evidence-based Practice, Richard Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA

    Kurt Kroenke MD

Authors
  1. Dennis C. Ang MD, MS
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  2. Kathleen Thomas DO
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  3. Kurt Kroenke MD
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Corresponding author

Correspondence to Dennis C. Ang MD, MS.

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Ang, D.C., Thomas, K. & Kroenke, K. An Exploratory Study of Primary Care Physician Decision Making Regarding Total Joint Arthroplasty. J GEN INTERN MED 22, 74–79 (2007). https://doi.org/10.1007/s11606-007-0111-x

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  • DOI: https://doi.org/10.1007/s11606-007-0111-x

Key words

  • total joint arthroplasty
  • primary care physicians
  • osteoarthritis
  • decision making